Out-Of-Network Utilization and Plan Selection Among Medicare Advantage Cost Plan Enrollees.

ABSTRACT:

Objective

To understand how Medicare Advantage (MA) networks impact utilization patterns and plan choices, using the 2019 discontinuation of MA 1876 Cost plans as a natural experiment.

Study setting and design

We study 1876 Cost plans, MA plans for which out-of-network care is covered through traditional Medicare (TM) and many of which CMS discontinued in 2019. We characterize the proportion of Cost plan enrollees who utilized out-of-network care in 2018 from different types of medical specialties. We then study how enrollees in discontinued plans selected into new plans in 2019. We use regression analysis to characterize whether higher risk enrollees selected into TM at higher rates.

Data sources and analytic sample

We identify discontinued plans using public MA plan

SUBMITTER: McCormack G 

PROVIDER: S-EPMC12047686 | biostudies-literature | 2025 Apr

REPOSITORIES: biostudies-literature